Earticle

Purpose: This study aimed to explore the current status of systematic review studies on patient-reported outcome measures (PROMS)published in Korean journals. Methods: Studies on the systematic review of PROMs, which applied the COnsensus-based Standards for selecting health MeasurementInstruments (COSMIN) methodology. There were searched from the KoreaMed. The studies were evaluated based on the eightsteps suggested by the COSMIN systematic review processes. Results: A total of eight systematic review studies were published in seven Korean journals. Patient-reported outcome measures(PROMS) measure for post-traumatic growth, social adjustment, physical impairment in post-intensive care syndrome, sleep quality,constipation, discharge readiness, post-traumatic stress disorder, and eHealth literacy. Conclusions: No studies adhered to the steps of the COSMIN systematic review guidelines. Among the steps, the weakest points weresearching strategies and evaluating measurement properties.

Purpose: This study was to determine how attitude, subjective norm, and perceived behavioral control (PBC) were related to parents' intentions to vaccinate their sons in elementary school against human papillomavirus (HPV), applying the updated theory of planned behavior. Two hypotheses were examined: PBC would moderate the relationship of attitude to intention and subjective norm to intention, respectively. Methods: This was a cross-sectional study with 231 participants recruited in November, 2018. Inclusion criteria for the participants were parents with 5th-6th grade boys in elementary schools. The moderation effects of the hypotheses were analyzed using the PROCESS macro for SPSS. Results: PBC significantly moderated the relationship of attitude to intention on HPV vaccination. The simple effect of attitude to intention was significant under three different levels of the PBC (low, moderate, and high), but the magnitudes of the relationships were not homogeneous. The magnitude of the relationship between attitude and intention was the lowest for the parents with the low level of the PBC. In the relationship of subjective norm to intention on HPV vaccination, the moderating effect of the PBC was not supported. Subjective norm and PBC directly predicted the intention on HPV vaccination. Conclusion: In order to promote the parents' intentions to vaccinate their sons in elementary school against HPV, we need a program that can improve parents’ attitude, subjective norm, and PBC, requiring special attention to the parents with the low PBC.

Purpose: The purpose of this study was to evaluate studies on the measurement properties of selfreported instruments. Method: This descriptive review included studies on measurement properties that were reported in Asian Nursing Research over a five-year period from 2016 to September 2020. Nine key measurement properties were reviewed for each study: content validity, structural validity, internal consistency, crosscultural validity/measurement invariance, reliability, measurement error, criterion validity, hypothesestesting construct validity, and responsiveness. Results: The most commonly applied measurement properties were structural validity and internal consistency. However, structural validity using confirmatory factor analysis or item response theory/ Rasch analysis needs to be rigorously analyzed and interpreted. None of the studies assessed measurement error and responsiveness. Conclusion: It is recommended for nursing researchers to assess measurement properties beyond structural validity and internal consistency using more rigorous methodologies.

Purpose: Patients with diabetes frequently need to perform certain numeric tasks such as interpreting blood glucose levels. However, there is no psychometrically sound instrument for objectively measuring diabetes-specific health numeracy. This study aimed to develop a new objective diabetes health numeracy test (DHNT) and evaluate its psychometric properties in adult patients with type 2 diabetes. Methods: An instrument development study was conducted. Initial items were evaluated by six experts for content validity. After a pilot test, a convenience sample of 257 participants with type 2 diabetes was recruited at 2 university hospitals from May to September 2018. The structural, convergent, and criteria validity, and internal consistency of the DHNT with binary item responses were evaluated. Data were analyzed using exploratory factor analysis, Rasch analysis, tetrachoric correlation, Spearman's correlation, and the KudereRichardson-20 formula. Results: Exploratory factor analysis yielded a single-factor solution comprising seven items. Rasch analysis confirmed that no item did not fit with the single factor and identified that the item difficulty parameters had moderate values. The convergent and criterion validity of the instrument were demonstrated, with diabetes knowledge and subjective diabetes numeracy, respectively, as was its acceptable internal consistency, by a KudereRichardson-20 coefficient of .81. Conclusion: The DHNT demonstrated satisfactory psychometric properties. The instrument with moderate levels of item difficulty may have a lower cognitive burden. The developed instrument can be applied in practice to tailor the education of diabetes self-management as per the levels of health numeracy of specific patients.

Purpose: This study aimed to evaluate the psychometric properties of the Depression Anxiety Stress Scales 21 and 12 in a Korean population. Methods: The Depression Anxiety Stress Scales were translated into Korean using a translation and backtranslation technique, and the content validity was assessed by an expert panel. Participants were recruited from six community health centers (n ¼ 431) and two community mental health centers (n ¼ 50). A field test of the psychometric properties of the instruments was conducted using confirmatory factor analysis with bootstrap maximum likelihood estimation involving 1,000 samples, Pearson's analysis, t test, and Cronbach's a coefficient. Results: Confirmatory factor analysis of the Depression Anxiety Stress Scales 21 and 12 supported both three-factor and second-order three-factor models. The Scales 21 and 12 satisfied convergent validity with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Perceived Stress Scale- 10 and discriminant validity with the Rosenberg Self-Esteem Scale. The scores for the Depression Anxiety Stress Scales 21 and 12 were higher for the psychiatric group than for the nonpsychiatric group, confirming the presence of known-groups validity. The Depression Anxiety Stress Scales 21 and 12 exhibited moderate-to-strong correlations with the Negative Affect. Cronbach's a coefficients for the Depression Anxiety Stress Scales 21 and 12 were .93 and .90, respectively. Conclusion: The Depression Anxiety Stress Scales 21 and 12 appear to be acceptable, reliable, and valid instruments. However, the shorter Depression Anxiety Stress Scales 12 may be more feasible to use in a busy practice and also be less burdensome to respondents.

Purpose: The purpose of study was to examine the relationship between obesity and its associated factors (psychiatric symptom, duration of illness, type of medication, physical activity, dietary habits, depressive symptom, and stress) in patients with chronic mental illness registered to community mental health welfare centers. Methods: This was a cross-sectional correlation study using a convenience sampling. A total of 392 participants were recruited from community mental health welfare centers. The obtained data were analyzed using binary and multinomial logistic regression. Results: Atypical antipsychotic medication, duration of illness, dietary habits (overeating, and drinking instant coffee) were significantly contributed variables into body mass index (BMI) obesity. Atypical antipsychotic medication and instant coffee were significantly related to abdominal obesity. Conclusion: These results emphasized the needs of tailored obesity-preventive management for the community-dwelling patients with chronic mental illness, topically focusing on the administration of atypical antipsychotic medication, duration of illness, and dietary habits.

Purpose: This study was conducted to examine the relationships of depression symptom, self-esteem, and stress with health-related quality of life(HRQOL) in patients with hypertension registered to a community health center. Methods: This study was a correlational survey using a convenience sampling. A total of 110 patients diagnosed with hypertension were recruited from a health center in Gyeonggi-do. The questionnaires used were the Cardiovascular Disease Specific-HRQOL questionnaire, Center for Epidemiologic Studies Depression, Rosenberg Self-Esteem Scale, and Perceived Stress Scale. The acquired data were analyzed using IBM SPSS version 22.0. Multiple linear regression analysis was performed. Results: Moderate depression symptom(β=-.368, p<.001), severe depression symptom (β=-.450, p<.001), stress(β=-.339, p=.001), and gender(β=-.148, p=.049) were significant predictors for the HRQOL. Multiple linear regression showed that 51.8% (R2=.518) of the variance in the HRQOL was explained. Conclusion: Based on these results, development of an intervention or education program, to decrease depression symptoms and stress is recommended. This may improve the HRQOL in patients with hypertension registered to a community health center.

Purpose: The aim of this study was to determine the prioritization of research topics by Korean oncology nurses. Methods: A descriptiveand cross-sectional survey was conducted via the website of the Korean Oncology Nursing Society, with participation soughtby email from all of its members. Results: Overall, ‘pain’ and ‘quality of life’ were the most important among the 74 topics, ‘cancer prevention’was ranked 47th, while ‘informatics’ and ‘telehealth’ were ranked 62nd and 72nd, respectively. Korean oncology nursing researchneeds to be expanded to include community-based cancer prevention. In addition, research on informatics and telehealth inthe oncology nursing area is necessary given the current dramatic changes in the implementation of information technology in medicalservices. Conclusion: These findings may contribute toward the development of a Korean oncology nursing research agenda andthe provision of information to funding agencies with respect to setting the priorities of oncology nursing research.

Purpose The purpose of this study was to review articles related to the psychometric properties of the Perceived Stress Scale (PSS). Methods Systematic literature searches of computerized databases were performed to identify articles on psychometric evaluation of the PSS. Results The search finally identified 19 articles. Internal consistency reliability, factorial validity, and hypothesis validity of the PSS were well reported. However, the test-retest reliability and criterion validity were relatively rarely evaluated. In general, the psychometric properties of the 10-item PSS were found to be superior to those of the 14-item PSS, while those of the 4-item scale fared the worst. The psychometric properties of the PSS have been evaluated empirically mostly using populations of college students or workers. Conclusion Overall, the PSS is an easy-to-use questionnaire with established acceptable psychometric properties. However, future studies should evaluate these psychometric properties in greater depth, and validate the scale using diverse populations.

Purpose: The purpose of this study was to review articles related to the psychometric properties of the Perceived Stress Scale (PSS). Methods: Systematic literature searches of computerized databases were performed to identify articles on psychometric evaluation of the PSS. Results: The search finally identified 19 articles. Internal consistency reliability, factorial validity, and hypothesis validity of the PSS were well reported. However, the test-retest reliability and criterion validity were relatively rarely evaluated. In general, the psychometric properties of the 10-item PSS were found to be superior to those of the 14-item PSS, while those of the 4-item scale fared the worst. The psychometric properties of the PSS have been evaluated empirically mostly using populations of college students or workers. Conclusion: Overall, the PSS is an easy-to-use questionnaire with established acceptable psychometric properties. However, future studies should evaluate these psychometric properties in greater depth, and validate the scale using diverse populations.

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The purpose of this study was to identify the factors that influence medication adherence and self-care among low-income older adults with hypertension. Methods: A sample of 297 low-income older adults with hypertension was recruited from June 30 to July 30, 2010. Data collection was done using a face-to-face interview with structured questions. The data were analyzed using descriptive statistics, Pearson's correlation coefficient,and path analysis. Results: Subjective health status, duration of hypertension, number of drugs excluding antihypertensives, body mass index, knowledge about hypertension, sense of coherence, benefit, barrier, and self-efficacy were identified as significant predictors. Subjective health status and duration of hypertension,knowledge, depression, and self-care showed direct effects on medication adherence. Depression had the strongest direct influence on medication adherence. Body mass index, benefit, self-efficacy, and depression showed a direct effect on self-care. Sense of coherence was a strong predictor of depression which significantly influenced on medication adherence and self-care. Conclusion: For enhancing medication adherence and self-care, it is suggested that a psycho-education program reducing depression and increasing knowledge about hypertension should be provided into low-income older adults with hypertension.

Purpose To evaluate a computerized self-reported, touch-screen version of the cancer-specific quality-oflife(cC-QOL) questionnaire against the traditional paper-and-pencil version (the pC-QOL) for equivalence, time for completion, user preference and ease of use. Methods One hundred and five patients were recruited from a cancer center of a university hospital in South Korea. A randomized crossover design was used, with patients randomly assigned into two groups. Group A patients completed the cC-QOL first while waiting to see a physician, and completed the pC-QOL version of the questionnaire after seeing the physician. Group B patients completed these questionnaires in the reverse order. Subjects were asked about user preference and ease of use. Time taken to complete both versions was measured. Results Weighted kappa coefficients of items showed very good to moderate agreement. The time required to complete the cC-QOL did not differ statistically from the pC-QOL. The same proportion of patients preferred both versions. Most patients (94.8%) reported that the cC-QOL was “easy” or “very easy” to complete. Conclusion The cC-QOL is the computerized equivalent of the pC-QOL, which is used to assess the health-related quality of life (HRQOL) of cancer patients. The cC-QOL can be helpful to oncology nurses and physicians for assessing, collecting, and evaluating their patients’ HRQOL scores in busy clinical practices.

연구 대상자의 증상경험은 21.96(SD=14.14), 정서적 상태는 110.95(SD=100.92), 사회적지지는 3.70(SD=0.98)로 나타났다. 증상경험과 정서상태는 유의한 정 상관관계(r=.396, p=.001)를 나타내었고, 증상경험과 사회적지지는 유의한 부적 상관관계(r=-.304, p=.003)를 나타내었다. 증상경험에 영향을 미치는 요인은 정서적 상태로 설명력이 16.5%이었다.이상의 연구결과 방사선치료를 유방암 환자의 증상경험과 환자의 정서적 상태가 관련이 됨을 알 수 있으나, 그 설명력은 약하므로 앞으로 더 연구하여야 할 영역이라 생각한다

It is reported that many cancer patients with pain, depression, and fatigue receive inadequate treatment for their symptoms. All patients with cancer should have optimal symptom control throughout the course of treatment. One of the important role of nurses is symptom management of patients in clinical practices. Nurses caring for breast cancer patients should be concerned about the distress of their patients who are undergoing treatment such as radiotherapy. In this study, the total score of symptom experience was 21.96, lower than that of 32.44 reported by Lee et al.(2004) for breast cancer patients with undergoing chemotherapy. This suggests that the symptom experiences of breast cancer patients receiving radiotherapy are less severe than those of breast cancer patients receiving chemotherapy. The result show that the highest score of sub-items of symptom experiences was fatigue(mean 4.18, SD=2.05), which was consistent with the previous study by Lee et al.(2004). Donovan et al.(2004) reported that chemotherapy was associated with more severe fatigue than radiotherapy. This study appears to confirm that fatigue is the most important distress of cancer patients undergoing either chemotherapy or radiotherapy. Breast cancer patients in the present study experienced a low-to-moderate level of mood disturbance. This finding was consistent with the study by Lee et al.(2004) that involved women receiving chemotherapy therapy for breast cancer. The score of social support is 3.70(SD=0.98). And the score of family support and health professional support were 3.94(SD= 1.03) and 3.47(SD=1.04), respectively. This result is similar with the study of Cimprich (1999) on women undergoing chemotherapy for breast cancer. Cimprich(1999) reported the pretreatment symptom distress in women newly diagnosed with breast cancer and that the mean score of family support from spouse, parents, siblings, children, or other extended family was 3.94(SD=1.03). This reported finding suggested that women recognized moderate to high level of social support. And also women percept more social support than professional support. According to Landmark, strandmach, & Wahl(2002), women with a new breast cancer diagnoses experienced both social support and lack of social support in their interactions with their close relatives, friends and colleagues, and institutional staff. Further, these researchers indicated a weak social network increased the patient's vulnerability whereas a strong social network increased the ability to cope with stress, distress, and cancer. Moreover, social support from health care professional was believed to promote feelings of wellbeing and coping in cancer patients(Landmark et al., 2002). Symptom experience and mood disturbance had a statistically significant positive correlation in this study. Similar result has been reported in a number of studies involving cancer patients receiving radiation. Manning- Walsh (2005) reported that symptom distress was related to psycho-spiritual well-being. Fulton (1997) also suggested a strong relation between anxiety and depression and sympto- matology. In sum, it appears that symptom experiences and mood disturbance are closely correlated in cancer patients undergoing treatments. Therefore, nurses caring for the breast cancer patients receiving radiotherapy should pay attention to their emotional status. The present study also indicated a statistically significant negative correlation between social support and mood disturbance (r=-.304, p=.003). This finding is consistent with a previous study involving breast cancer patients(Lee et al., 2004) and confirms the efficacy of social support to achieve the goal of patient's symptoms management. Potential interventions may be targeted at emotional reactions and social support in order to manage patients' symptoms effectively. But there was no significant correlation between symptom experience and social support. Bleaker, Pouwer, Ploeg, Leer, & Adere...

Purpose: The purpose of the present study was to analyze and evaluate prior studies published in Korea on the cardiovascular disease-related quality of life, in order to make recommendations for further research. Methods: A total of 15 studies were selected from four databases(Digital library of Research Information Center for Health, Korea Medical Database, MedRic, and National Assembly Library). The selected studies were analyzed according to criteria, such as diagnosis/operation, used instrument, generic/specific instrument, dimension of quality of life, translation/ back-translation, sample size, reliability, validity, responsiveness, number of items, type of scale, time required, and independent variables. Results: Of the 15 cardiovascular disease-related quality of life studies, approximately half of them were conducted with hypertension or ischemic heart disease patients. All studies asserted that the concept of quality of life had multidimensional attributes. With respect to the questionnaire used for measuring the quality of life, only one study used a cardiovascular disease specific- instrument and most studies did not consider whether or not the validity of their instrument had been established. In addition, when using questionnaires developed in other languages, only one study employed a translation/ back-translation technique. The types of variables tested for their influence on quality of life were quite limited. Conclusion: It is recommended to develop a reliability and validity established cardiovascular disease specific- quality of life for Korean patients and to identify associated new variables.

This study was conducted to develop and evaluate guidelines for cancer patients' symptoms management such as nausea/vomiting, fatigue, constipation, diarrhea, and oral mucositis. Based on the literature review, assessment path to identify each stage of five symptoms were also developed. Guidelines for symptom management of each stage of the symptoms were developed. Guidelines then were evaluated by a panel of experts. Finally, 95 cancer patients were recruited and asked to use the guidelines for their symptom management. Levels of understanding of and satisfaction with assessment path and management guidelines were surveyed. Prevalence rate of five symptoms varied ranging from 20% (diarrhea) to 47% (nausea/vomiting). Regarding the level of understanding of each symptom most of the cancer patients indicated that they were easy and sufficient. Regarding the easiness of use of the symptom management guidelines, most of cancer patients indicated that they were easy to use. Regarding the nursing intervention on each symptom, most of cancer patients indicated that they were easy and helpful. More information was added with feedback from the patients. The result of this study has implications on development of customized patient education materials based on assessment path and symptom management guidelines.

본 연구는 암 환자가 경험하는 삶의 질을 파악하는 것으로 질적 연구 방법의 하나인 근거이론 방법을 이용하였고, 그 결과 핵심범주는 “안녕상태 유지하기”로 나타났다. ‘안녕상태 유지하기’를 위해서 암 환자는 몸 다스리기, 마음 다스리기, 정보찾기를 하였는데, 이것들은 대부분 배우자 및 확대가족의 지지를 받으며 이루어졌다. 또한 점을 보는 방법을 이용하기도 하였고, 몸 다스리기의 일부인 민간 요법을 사용하였으며, 부모에 대한 불효라는 생각을 가지고 있었다. 이것들은 모두 한국적 특성을 반영한 것이라고 하겠다. 본 연구를 통해 생성된 삶의 질이라는 개념의 의미와 속성은 학술적으로 한국 암 환자의 삶의 질에 대한 이론적 이해의 폭을 넓히는데 기여할 것이고, 또한 한국 암 환자 삶의 질 측정도구에 필요한 내용을 제공할 수 있으며, 더 나아가 실무적 측면에서는 암 환자 삶의 질 증진을 위한 중재법 개발의 초석으로 작용할 것으로 기대된다.

The purpose of the study was to understand and explore the quality of life in cancer patients in the context of a Korean culture and society. Grounded theory method guided the data collection and analysis. A total of 10 cancer patients was selected by a theoretical sampling. The data were collected by an open question. All interviews were audio taped and transcribed verbatim. Constant comparison analysis was employed to analyze the data. As the results, eighty-five concepts and twelve categories were emerged, and "keeping well-being status" identified as a core category. Quality of life related categories derived from this study will academically contribute to the understanding and expansion of theoretical bases for quality of life of Korean cancer patients and to the contexts for the development of measurement of quality of life. Furthermore, they will function as the foundation of a intervention development for quality of life.